To determine whether or not it was fair that the family could request to place their father on “massive IV vitamin therapy,” we must first be vigilant in understanding the facts of the case. We know that the patient’s “trachea could not be repaired.” At first, the family desired to discontinue his treatment, due to the understanding that the patient was “semicomatose”, “incapable of participating” in making decisions for himself, and on the verge of “inevitable death from sepsis and respiratory failure.” Secondly, the initial decision of withdrawing further treatment in an attempt to make the patient as comfortable as possible was revisited after the eldest daughter had made her way to see her father. Thus, there are multiple sides involved in this ethical dilemma concerning the patient’s well-being and further course of treatment that could and should be taken. There is the patient’s side; though the patient is incapable of making decisions, he is still a human being and deserves to be treated as such. To act in such a way would uphold the ethical principle of beneficence, which is focused on doing good and acting in such a way that protects one from harm and discomfort. (Burkhardt & Nathaniel, 2014) The next person/group of people who should be accounted for is the immediate family of the patient. They are involved with the patient emotionally and out of love and care for the father, seeing as they try to do everything they can to keep their father alive. They are the advocates for the patient who no longer can make decisions for himself. The largest factor in carrying through with the plan and hopes for the care of the patient would be Trevor, the RN in charge of patient care, as well as the physician overseeing and writing the physician’s orders on behalf of the patient. A factor that should not even be considered over the patient’s well-being is money and the cost of treatment. The care and comfort of the patient must always come first, according to Provisions 1 through 3 of the ANA Code of Ethics.
The ethical dilemma lies in the fact that the family has requested (and the physician has granted the family’s wishes) to place the father on massive IV vitamin therapy, although the father is inevitably going to die due to sepsis and respiratory failure. The family’s intentions are good and are centered around the well-being of the patient, however, Trevor feels that this is wrong because he knows that this order will only grant the family a false sense of hope, seeing as it is too late to treat the patient back to health. Trevor most likely wants to focus time and resources on making the father as comfortable as possible, rather than subjecting him to a treatment that is of no use. The physician had argued that they could keep him on the massive IV vitamin therapy since the father would not feel it and though it was not benefiting the patient, it was neither harming him at the same time. The family does have a right to request such a treatment, though being unaware that the treatment will be of no use. The family is acting on the ethical principle of beneficence because they are trying to do good for the patient by trying to save his life. (Burkhardt & Nathaniel, 2014) They are not trying to harm the patient, and even if they were, they would not be intentionally doing so because they were not made aware of the true nature of the medicine and the accurate medical outcome of the treatment. The physician and supervisor have not upheld the ethical principle of veracity, which is essentially, “truth-telling.” (Burkhardt & Nathaniel, 2014) Though they are not directly lying, they are at the same time withholding the truth. However, this ethical principle, though not upheld, still upholds the ethical principle of beneficence, and even more so, the ethical theory of deontology, which focuses on the intention of an act rather than the outcome. (Burkhardt & Nathaniel, 2014). Since the outcome of the patient will not change regardless of the massive IV vitamin therapy, the physician and supervisor believe that their action is justified because the nature of their intent is good, which is to try and give the family hope (false hope, but hope still nonetheless). It is also important to note that the ethical principles of beneficence (to do good and protect one from harm) and nonmaleficence (to not harm) are quite often used interchangeably due to having similar definitions. (Burkhardt & Nathaniel, 2014) However, this situation covered is a unique instance in which beneficence and nonmaleficence conflict with each other. This is because to uphold beneficence, the RN must be truthful and treat the patient in such a way that minimizes discomfort, at the cost of harming the patient’s family emotionally (though not intentionally). Nonmaleficence could not be upheld because if the family was informed that the truth was withheld from them, their emotions would be harmed, as well as their trust in the very place of healthcare that they had initially trusted and placed their father in.
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The reason why Trevor feels uncomfortable with the physician’s orders and also upholding the family’s wishes is because first and foremost, his duty is to his patient, according to Provision 2 of the ANA Code of Ethics. Furthermore, Provision 3 of the ANA Code of Ethics states that “The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient.” Trevor’s ethical belief in veracity is targeted, since he is not telling the truth (or at least all of the truth) when giving the patient a medication that does not work at all. Provision 1 of the ANA Code of Ethics is concerned and centered around protecting the dignity and worth of the patient. Thus, this Provision relates to the given case situationally. If we knew that the patient’s wishes were to always tell the truth to the family, then giving the truthfully “medically useless” treatment would not be upholding the patient’s wishes. However, if the patient wanted to save the heartache, at least for a moment for the family, then Trevor and the physician’s actions would be upholding the patient’s dignity, perceived worth, and Provision 1 of the ANA Code of Ethics. The problem is that we do not know what the patient’s wishes are. At the same token, to give medication that has no actual medical benefit to the patient would essentially be like giving placebo medication to the patient, without his informed consent. (Burkhardt & Nathaniel, 2014) The patient, since incapable of making a decision, was unable to be granted his right to informed consent from and by his healthcare providers. “Informed consent is the practical application of the principle of respect for autonomy.” (Burkhardt & Nathaniel, 2014) The patient’s right to autonomy was not respected. The family’s informed consent wasn’t given either, however, it becomes a question of whether or not informed consent was even needed in the first place. Since the family requested the treatment, was there request enough to suffice as valid consent? Yes, it would be consent since they requested and ultimately consented to the treatment. The issue is that the consent was made without being fully informed. They were not fully informed that the medical treatment and course of health care to be made through massive IV vitamin treatment would be of no benefit to the patient.
Ultimately, Provision 5 of the ANA Code of Ethics would give the best guidance for Trevor who is unsure of how to proceed. Provision 5 states that “The nurse owes the same duties to self as to others, including the responsibility to preserve integrity and safety, to maintain competence, and to continue personal and professional growth.” As previously stated, Trevor has a desire to uphold his integrity and has a right to do so, according to this provision. His competence would not be maintained if he knew that he was giving medication that had no benefit at all to the patient. Finally, this dilemma would test Trevor’s character, and ultimately be a catalyst for his “personal and professional growth.”
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